全腰椎融合术后，哪些日常功能受僵硬影响最大：上胸椎与胸腰段近端终点的比较
Which daily functions are most affected by stiffness following total lumbar fusion: comparison of upper thoracic and thoracolumbar proximal endpoints.
作者信息
Sciubba Daniel M, Scheer Justin K, Smith Justin S, Lafage Virginie, Klineberg Eric, Gupta Munish, Mundis Gregory M, Protopsaltis Themistocles S, Kim Han Jo, Hiratzka Jayme R, Koski Tyler, Shaffrey Christopher I, Bess Shay, Hart Robert A, Ames Christopher P
机构信息
*Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD †Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL ‡Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA §Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY ¶Department of Orthopaedic Surgery, University of California, Davis, CA ‖San Diego Center for Spinal Disorders, La Jolla, CA **Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY ††Department of Orthopaedic Surgery, Oregon Health & Science University, Portland, OR ‡‡Rocky Mountain Hospital for Children, Denver, CO; and §§Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA.
出版信息
Spine (Phila Pa 1976). 2015 Sep 1;40(17):1338-44. doi: 10.1097/BRS.0000000000000968.
STUDY DESIGN
Retrospective review of a multicenter, prospective adult spinal deformity (ASD) database.
OBJECTIVE
The objective was to evaluate the impact of stiffness on activities of daily living (ADL) after instrumented total lumbar fusions to the pelvis; specifically between patients with the upper-most instrumented vertebra (UIV) within the upper thoracic (UT) versus the thoracolumbar (TL) region.
SUMMARY OF BACKGROUND DATA
The Lumbar Stiffness Disability Index (LSDI) has been validated and used in clinical studies as a self-reported outcomes tool; however, the impact of stiffness on the 10 specific ADLs comprising the LSDI has not been evaluated.
METHODS
A retrospective comparison of prospectively collected pre- and 2-year minimum postoperative answers to the 10 questions comprising the LSDI among patients with ASD was conducted. Cohorts were defined based on the UIV as UT (T1-T6) or TL (T9-L1).
RESULTS
134 patients were included (UT:64, TL:70). Both groups had statistically similar changes in all individual LSDI scores at 2 years versus preoperative values (P > 0.05l) with the exception of questions #2 (Bend through your waist to put socks and shoes on) and #8 (bathe lower half of body) in which UT reported increased difficulty (P < 0.05). Both groups had statistically similar individual LSDI question scores with the exception of 2-year question #4 (hygiene after toileting) in which UT had a significantly worse score (P < 0.05).
CONCLUSION
Patients with ASD undergoing instrumented total lumbar fusions to the ilium report limited changes from baseline in the ability to perform the 10 ADL functions of the LSDI and had limited differences in final scores regardless of whether the UIV was in the UT or TL region. Domains showing the greatest change from baseline involved dressing or bathing the lower half of the body among patients with UT. The only domain for which UT had greater impairment was in performing personal hygiene functions after toileting.
LEVEL OF EVIDENCE
研究设计
对一个多中心前瞻性成人脊柱畸形（ASD）数据库进行回顾性分析。
目的
评估骨盆固定全腰椎融合术后僵硬程度对日常生活活动（ADL）的影响；具体比较上胸椎（UT）区域与胸腰段（TL）区域内最上位固定椎体（UIV）的患者之间的差异。
背景数据总结
腰椎僵硬残疾指数（LSDI）已得到验证，并在临床研究中用作自我报告的结局工具；然而，僵硬程度对构成LSDI的10项特定ADL的影响尚未得到评估。
方法
对ASD患者前瞻性收集的术前及术后至少2年对构成LSDI的10个问题的回答进行回顾性比较。根据UIV将队列定义为UT（T1 - T6）或TL（T9 - L1）。
结果
共纳入134例患者（UT组：64例，TL组：70例）。与术前值相比，两组在术后2年时所有个体LSDI评分的变化在统计学上均相似（P > 0.05），但问题2（弯腰穿袜子和鞋子）和问题8（清洗下半身）除外，UT组报告难度增加（P < 0.05）。两组个体LSDI问题评分在统计学上相似，但术后2年问题4（如厕后卫生）除外，UT组得分明显更差（P < 0.05）。
结论
接受骨盆固定全腰椎融合术的ASD患者报告，在执行LSDI的10项ADL功能方面，与基线相比变化有限，无论UIV位于UT还是TL区域，最终得分差异也有限。与基线相比变化最大的领域涉及UT组患者的下半身穿衣或洗澡。UT组受损更严重的唯一领域是如厕后进行个人卫生功能。
证据水平
3级。
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